Provider Demographics
NPI:1265663819
Name:EVANS, EILEEN A (MA RD)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:A
Last Name:EVANS
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Gender:F
Credentials:MA RD
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Mailing Address - Street 1:111 ELWYN RD
Mailing Address - Street 2:KIVITZ BUILDING
Mailing Address - City:ELWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4622
Mailing Address - Country:US
Mailing Address - Phone:610-891-2272
Mailing Address - Fax:610-891-2269
Practice Address - Street 1:111 ELWYN RD
Practice Address - Street 2:KIVITZ BUILDING
Practice Address - City:ELWYN
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2272
Practice Address - Fax:610-891-2269
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
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Provider Licenses
StateLicense IDTaxonomies
PADN003147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered